The role of serum osmolality in Meniere's disease with acute sensorineural hearing loss

Relationship between vestibular schwannoma and endolymphatic hydrops

BACKGROUND

Both vestibular schwannoma (VS) and Meniere's disease (MD) patients underwent hydrops MRI to clarify the relationship between VS and endolymphatic hydrops (EH).

METHODS

Eighty patients with VS or MD underwent an inner ear test battery followed by hydrops MRI, and were then divided into 3 groups. Group A comprised 58 MD patients (62 ears) with positive EH but negative VS. Group B included 18 VS patients (18 ears) with negative EH, while Group C consisted of 4 patients (4 ears) who had VS concomitant with EH. Another 14 MD patients who tested negative for EH on hydrops MRI were initially excluded from this cohort, but were later included for comparison.

RESULTS

The decreasing prevalence of EH at the cochlea, saccule and utricle in Group A was identified in 59 (95%), 42 (68%) and 40 (65%) ears, respectively, mimicking a declining sequence of abnormality rates running from audiometry (86%), cervical vestibular-evoked myogenic potential (cVEMP) test (55%) to the ocular (oVEMP) test (53%). However, such decreasing trend was not identified in Groups B and C. In Groups C and A combined, 4 (6%) of 62 EH patients had concomitant VS. Conversely, 4 (18%) of 22 VS patients in Groups C and B combined had concurrent EH.

CONCLUSION

A very low (6%) rate of VS in EH patients indicates that VS in EH patients may be coincidental. In contrast, EH was identified in 18% prevalence of VS patients, mirroring the 22% prevalence of cochlear EH demonstrated in VS donors through histopathological studies.

Potential Application of Hydrops MR Imaging: A Systematic Review

BACKGROUND

Diagnostic dilemma between clinical Meniere's disease and radiological endolymphatic hydrops (EH) has emerged since the introduction of hydrops magnetic resonance imaging (MRI). The aim of this study is to explore the potential application of hydrops MRI on diagnosing the EH.

METHODS

This review was developed from peer-reviewed articles published in those journals listed on journal of citation reports. The MEDLINE database of the US National Library of Medicine, Scopus, and Google Scholar were used to collect articles based on the guidelines (PRISMA 2020 statement) for reporting reviews.

RESULTS

Initially, 470 articles were retrieved from 1983 to 2023, and 80 relevant articles were ultimately selected. The sensitivity (69%-92%) and specificity (78%-96%) values varied from each laboratory for detecting EH via hydrops MRI, probably due to candidate selection and the grading system employed.

CONCLUSION

The application of hydrops MRI allows (1) differentiation between EH and sudden sensorineural hearing loss; (2) determination of the affected side of EH; and (3) confirmation of the diagnosis of EH concomitant with other disorders. Notably, not all differentials for EH can be visualized on MR images. One of the existing gaps to be filled is that updated hydrops MRI fails to identify distortion, that is, rupture, collapse, fistula, or fibrosis of the inner ear compartments, akin to what histopathological evidence can demonstrate. Hence, enhanced ultrahigh resolution of hydrops MRI is required for demonstrating fine structures of the inner ear compartments in the future.

Evolution of geriatric Meniere's disease during the past two decades

BACKGROUND

This study compared the incidence of Meniere's disease (MD) in the elderly aged >65 years between the first (2001-2010) and second (2011-2020) decades to investigate the evolution of geriatric MD.

METHODS

Totally, 1605 and 2550 patients with definite MD were experienced at the neurotological clinic during the first and the second decades, respectively. All patients were divided into three groups by 30-year age band, namely elderly (aged 65-94 years), adult (aged 35-64 years) and young (aged 5-34 years) groups, and underwent an inner ear test battery. Factors relating to the incidence of MD during the past two decades were analyzed.

RESULTS

The elderly MD group comprised 198 (12.4%) of 1605 MD cases during the first decade, and 463 (18.2%) of 2550 MD cases during the second decade, showing a significantly increased incidence of elderly MD. Correlation between annual life expectancy (x) in Taiwan and annual prevalence (y) of the elderly MD in relation to total MD cases revealed y = 0.023x - 1.660 via linear regression analysis. In contrast, the adult MD group significantly differed in terms of age and gender ratio, but not incidence, between the two decades. Conversely, the young MD group exhibited significantly decreased incidence from the first decade (22.3%) to the second decade (13.8%).

CONCLUSION

Evolution of geriatric MD during the past two decades reveals an increased incidence of the elderly MD patients, likely due to increased life expectancy coupled with altered life style.